Doctor and activist


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Category: Health

Djokovic Fiasco reflects no credit on Australia

6 January 2022

Most people know that Novak Djokovic is pushing to be the Greatest tennis player Of All Time (GOAT) and needs just one Grand Slam victory to achieve this. Most also know he has been very successful in the Australian Open, which starts next week.  There is little doubt that a lot of people, myself included would be very interested in whether he can win after his failure against Medvedev in the US Open.

Many people are aware that he has been anti-vax and he unwisely attended a tournament last May and he and a number of others got COVID19, presumably by the Delta variant, but this is not recorded.

He has never been a popular as the smooth Roger Federer, or the rougher battler Raphael Nadal who are his great rivals for the GOAT title.  He was seen as not quite as warm a character.  He was praised by the President in his native Serbia for his early victories, but this cooled a bit when he made politically progressive statements.  His anti-vaxx statements have been frankly embarrassing.

Australia has a rule that if you are not vaccinated you cannot have a visa. 

Whether this should be the only criterion for entry should be a moot point.  With most infectious disease, having antibodies at a certain level assumes that you are immune to reinfection with the same disease.  This works for polio, but with ‘flu, where the virus changes, people get infected by a different strain every year.

The CDC (US Centre for Disease Control) guidelines are somewhat equivocal about antibodies. They will not say that having antibodies means either than you cannot be infected or that any infection will be minor.  It seems that COVID is considered more like ‘flu than polio.

It was not clear on what ground Tennis Australia allowed him to come, but now Border Force have excluded him, and the Prime Minister smugly talks about rules being rules.

It is important that we are protected, and many Australians have endured a lot of suffering in lockdown to achieve this, so they have little time for people to be treated differently.  But if Djokovic had COVID 6 months ago, it is hard to believe that he constitutes a high risk when the whole country has decided to abandon masks, distancing, QR codes and venue number restrictions. One might wonder what his antibody status is, or whether this was known.

It is important that various agencies in a country remain independent. We do not want Border Force deciding medical issues, nor Tennis Australia deciding immigration policy.  But Australia looks pretty silly, when one group allows him and another does not.  As a tennis watcher, I would like to see him play, and it does seem that the politics are overcoming the science. 

Now we bring in the lawyers, another idiot factor?

www.smh.com.au/sport/tennis/novak-djokovic-launches-court-bid-to-fight-deportation-20220106-p59mdp.html

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Fake Science now an Industry

6 January 2022

Many years ago (?1977), I applied for the job as editor of the Medical Journal of Australia.  I had done two years as a surgical trainee and took a year off from the somewhat disillusioning hierarchical system.  I had done 3 and a half years of university English, but in terms of my experience editing, it was perhaps a long shot.

The salary was roughly the same as a second year resident, though more than half that salary had been overtime.  The job seemed a bit of dangerous niche, but it was worth thinking about.  I didn’t get the job (Dr Alan Blum from the US did), but was invited to apply for Deputy Editor.  The salary here was $20,000 less, which was more than a third. But the key reason I declined is that I hate having someone else waste my time. 

There is such an incentive to publish in order to climb academic ladders that most writing is done for the writer, not the reader.  As many papers are written as possible, so the idea of spending a lifetime sorting through thousands of papers to find ones of merit seemed a hazardous occupation with a great danger of drudgery.

When I thought about the issue I devised the Chesterfield-Evans theory of knowledge acquisition. It is an exponential graph with time on the horizontal axis and knowledge in the vertical.  With a little time you can get quite a lot of knowledge, but to get a little more or to get the forefront takes an immense amount of time, for the last bit of knowledge. This extra bit of knowledge may be well rewarded financially in medicine if you get it ‘approved’ as a specialty, but in many scientific endeavours there is no reward at all.  Getting to the forefront is made harder by the lack of incentive to write concise papers for the benefit of the reader.

In practices as a medical professional the explosion of information of indifferent quality has made reliance on key journals the easiest way to go, but even here the increased specialisation makes even being a reasonable generalist more difficult. The monetisation of knowledge makes the specialties not want to share all their information, the college and universities act like businesses and the drug companies want to sponsor a certain view.

When I wrote both my Masters theses, getting a good supervisor was a problem. No one really wanted to go through the writings of yet another postgrad.  My supervisor, Dr Chris Winder said that he would simply prefer students write concise papers and send the lot to a publisher, giving degrees to the ones considered worthy of publishing. 

But there has been a profusion of journals, initially driven by the profitability of these.  Now the pressure from students has been joined by a rogue element, the dodgy rip-off factories.  Plagiarism and now straight out fraud are now industries.

Those who seek knowledge now have to be more discerning. There is delight amongst the non-scientific who can, like Pontius Pilate ask, ‘What is truth’ and then also like Pilate not want to know the answer.

Sadly, politicians and managers who have agenda other than optimal knowledge are flourishing  in this environment.

I am glad that I did not become a medical editor; it is hard enough getting a broad-based knowledge of reasonably indisputable facts.

I am quite unsure how the confluence of factors favouring ignorance can be countered.  Making everyone learn some science and maths at school might be a start.

How fake science is infiltrating scientific journals

Harriet Alexander

January 5, 2022

In 2015, molecular oncologist Jennifer Byrne was surprised to discover during a scan of the academic literature that five papers had been written about a gene she had originally identified, but did not find particularly interesting.

“Looking at these papers, I thought they were really similar, they had some mistakes in them and they had some stuff that didn’t make sense at all,” she said. As she dug deeper, it dawned on her that the papers might have been produced by a third-party working for profit.

“Part of me still feels awful thinking about it because it’s such an unpleasant thing when you’ve spent years in a laboratory and taking two to 10 years to publish stuff, and making stuff up is so easy,” Professor Byrne said. “That’s what scares the life out of me.”

The more she investigated, the more clear it became that a cottage industry in academic fraud was infecting the literature. In 2017, she uncovered 48 similarly suspicious papers and brought them to the attention of the journals, resulting in several retractions, but the response from the publishing industry was varied, she said.

“A lot of journals don’t really want to know,” she said. “They don’t really want to go and rifle through hundreds of papers in their archives that are generated by paper mills.”

More recently, she and a French collaborator developed a software tool that identified 712 papers from a total of more than 11,700 which contain wrongly identified sequences that suggest they were produced in a paper mill. Her research is due to be published in Life Science Alliance.

Even if the research was published in low-impact journals, it still had the potential to derail legitimate cancer research, and anybody who tried to build on it would be wasting time and grant money, she said. She has also suggested that journals could flag errors while articles were under investigation, so people did not continue to rely on their findings during that time.

Publishers and researchers have reported an extraordinary proliferation in junk science over the last decade, which has infiltrated even the most esteemed journals. Many bear the hallmarks of having been produced in a paper mill: submitted by authors at Chinese hospitals with similar templates or structures. Paper mills operate several models, including selling data (which may be fake), supplying entire manuscripts or selling authorship slots on manuscripts that have been accepted for publication.

The Sydney Morning Herald has learned of suicides among graduate students in China when they heard that their research might be questioned by authorities. Many universities have made publication a condition of students earning their masters or doctorates, and it is an open secret that the students fudge the data. The universities reap money from the research grants they earn. The teachers get their names on the papers as contributing authors, which helps them to seek promotions.

International biotechnology consultant Glenn Begley, who has been campaigning for more meaningful links between academia and industry, said research fraud was a story of perverse incentives. He wants researchers to be banned from producing more than two or three papers per year, to ensure the focus remained on quality rather than quantity.

“The real incentive is for researchers to get their papers published and it doesn’t have to be right so long as it’s published,” Dr Begley said. He recently told the vice-chancellor of a leading Australian university of his frustration with the narrative that Australia was “punching above its weight” in terms of research outcomes. “It’s outrageous,” Mr Begley told the vice-chancellor. “It’s not true.”

“Yes,” the vice-chancellor replied. “I use that phrase with politicians all the time. They love it.”

According to one publishing industry insider, editors are operating with an element of wishful thinking. This major publishing house employee, whose contract prevented him from speaking publicly, said when his journal started receiving a torrent of applications from Chinese researchers around 2014, the staff assumed that their efforts to tap into the Chinese market had borne fruit. They later realised that many of the papers were fraudulent and acted, but he was aware of other editors who turned a blind eye.

“Obviously there’s so much money in China and the journals have their shareholders to answer to, and they are very careful not to tread on Chinese toes because of the political sensitivity,” he said. “There’s a lot more they could do to sort the good from the bad because there is good science going on in China, but it’s all getting a bad name because of what some Chinese people have worked out — that there’s a market here for a business.”

Last month, SAGE journals retracted 212 articles that had clear evidence of peer review or submission manipulation, and subjected a further 318 papers to expressions of concern notices. The Royal Society of Chemistry announced last year that 68 papers had been retracted from its journal RSC Advances because of “systematic production of falsified research”.

To indicate the upswing in cases, German clinical researchers reported last week that in their analysis of osteosarcoma papers, just five were retracted before the millennium and 95 thereafter, with 83 of them from a single, unnamed country in Asia. University of Munster Professor Stefan Bielack, who published the study in Cancer Horizons, said some open access journals charged academics US$1500 to $2000 to publish their work, so they were more interested in publishing lots of papers than their scientific validity.

“There is a systematic problem and in some countries people might have the wrong incentives,” Professor Bielack said. “I think the journals have a major role. They all need to be more rigorous.”

The problem is not confined to China, but it has accompanied a dramatic growth in research output from that country, with the number of papers more than tripling over the last decade.

In 2017, responding to a fake peer review scandal that resulted in the retraction of 107 papers from a Springer Nature journal, the Chinese government cracked down and created penalties for research fraud. Universities stopped making research output a condition of graduation or the number of articles a condition of promotion.

But those familiar with the industry say the publication culture has prevailed because universities still compete for research funding and rankings. The number of research papers produced in China has more than tripled over the last decade, with dramatic growth over the past two years. The Chinese government’s investigation of the 107 papers found only 11 per cent were produced by paper mills, with the remainder produced in universities.

Until last year, University of NSW offered its academics a $500 bonus if they were the lead author in a prestige publication and $10,000 if they were the corresponding author of a paper published in Nature or Science. The system, which was designed to reward quality over quantity, was discontinued due to financial constraints.

But others have questioned whether the quality of a paper can be measured by the journal in which it is published, and an open access movement has sprung up in opposition to the scientific publishing industry, arguing that research paid for by taxpayers should be freely available to all.

Alecia Carter, an Australian biological anthropologist at University College London, said the emphasis on getting published in a high-impact journal rewarded sensational results over integrity, positive results over negative results and novel findings over building the evidence base. Researchers might inflate effect sizes or omit conflicting evidence because it muddied the overall story they were trying to tell.

“We as scientists know all these things that are wrong with the way the system is set up, but we still play the game,” Dr Carter said. “We’re all chasing the same thing.”

Dr Carter boycotts luxury journals, publishes as much as possible in open access journals and reports negative results, though this has come at a cost to her career. She was once asked at a job interview why she would bother reporting results that were not interesting.

“I said, ‘If it’s interesting enough to do the research then we should publish the results’.”

She did not get the job.

Here is an SMH article which stimulated my post:

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COVID Day 4- a non-PCR Day

5 January 2022

I did nothing today- it just took longer than usual.

I felt much the same, a sore throat, not much energy, a bit of a headache and bouts of a dry cough. I did not feel like exercise and I thought that I had better try to get a PCR test and some Rapid Antigen tests in case we needed to prove we were not infectious, or had other people who were concerned contacts.

I researched online where the PCR (Polymerase Chain Reaction) tests were being done. The site I used 2 weeks ago, a 4Cyte drive through test that had taken an hour to do and 3 days and 16 hours to get results from was closed Wed-Friday. It was not clear why this was but the Laverty Pathology group at 60 Waterloo Rd near Macquarie Centre was open till 4pm. I took a novel in case of a long wait and drove there.

As I approached from the google direction cars in the left lane were not moving from the major intersection as far as one could see to the next hill. Many of them had their tail lights on, so I reflected that they were sitting in a line with the engines on. Bad for the environment, but it at least told me that his was the queue. I turned off the engine and started to read. After a while I was wondering why no progress at all was being made, and I thought I might ask if I was under some misapprehension. As I looked up, a pleasant looking woman in her mid-30s got out of the small car ahead, and went to her boot.

I called to her out the window, ‘Is this the PCR test queue?

‘Reckon so’, she said, ‘I’ve brought some snacks to get through it’. She took some biscuits, grapes and a drink and got back in.

We advanced glacially slowly, and I noticed that there was a side road a little way down the queue. Space had been left so cars could go in and out of this side road, but cars had also started to queue there, and of course the two queues merged at the intersection. I had not thought of this until I was nearly at the corner, and I suppose the woman in the car hadn’t either. Some on the side road were shouting abuse or tooting as if we were somehow pushing in to their queue. There were no signs, no guides and nothing online, so it seemed that the only fair thing to do was to take alternate cars. My young friend had recognised this before I had and moved her car across the middle of the side road, so that cars exiting or entering could go in front or behind her, but she could be sure that the side road queued cards did not just push in. There was a cacophony of abuse from the side street.

The queue moved forward a few cars, so I followed her closely, letting one car in as seemed fair. A large 4WD with a man screaming obscenities at me tried to push in, but I kept him out. I wondered if he would get out and make trouble but he did not. The passenger in the car I had let ahead of me had got out and was remonstrating with the woman who had been in front of me. It was tense. I was very glad we were not in America with some people having guns.

We continued our glacial advance, then a car coming in the other direction stopped. The driver stuck his head our and was shouting something to those in the queue ahead of me. I could not hear him, but he did not seem abusive, so as he passed I called to him to ask what he had said. He said, ‘They have closed early; I was second in the queue and they told me to go away’. It seemed likely that he was right, but most people had waited so long that they were not willing to drive off, so we moved quite slowly till everyone had driven past the ‘Closed’ sign that had appeared in the driveway. It was 2pm. The testing site was advertised to be open till 4.

No test and a couple of hours wasted. I have COVID. It is not recorded in the system. It seems that I will recover. Will I waste another few hours tomorrow? And if I do will I have PCR results anyway? I am scheduled to see my patients again 9 days after the onset of symptoms- presumably I will be non-infectious. Luckily I got some RAT kits.

It is not hard to see where anger and frustration comes in all of this.

‘Personal responsibility’ has a very Darwinian edge.

Thank God I am not very sick.

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COVID Up Close

2 January 2022

I have tried to stay COVID safe, but we had a house guest, a friend of my son, Mike who had been stranded overseas for a year and came back to Brisbane and then to Sydney last Tuesday.  On Thursday he had a cough, so I asked him to Rapid Antigen Test (RAT), and he was positive.  Mike and I were negative, but the separation was minimal.

I was feeling a bit of a sore throat, headache and cough like an early flu and I managed to get another RA Test kit today (Sunday) and got a positive result.  Luckily, I had my 3rd vaccination 10 days ago, which is just long enough for it to start to work, so I am hopeful it will be a mild one.

It is ironic that I have had lots of requests to go back into the hospital workforce and resisted.

I will keep you posted. 

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It is Hard to get COVID tests and likely to get Harder

1 January 2022

The numbers of COVID cases are rising dramatically, many of the clinics have closed for Christmas, and Rapid Antigen Tests (RATs) have sold out from most chemists. You might wonder why this wasn’t anticipated, but it seems that the strategy of ‘Let ‘er Rip’ was meant to stimulate the economy as everyone assumed that either COVID was over, or that the Omicron variant did not matter, (not that Delta had actually gone away).

In fact the people have been mostly quite sensible and are not going out and are wearing masks and isolating, which of course means two things.

1. The ‘Let ‘er Rip’ strategy is not getting the economy back to normal and

2. The government can say that it is not their fault if people choose not to go out and spend, so they don’t need to support business or anyone else.

Here is an explanation of the PCR test unavailability from Kim Hatton:

‘Some people today have been wondering why the Feds are pushing so strongly to reduce PCR testing for COVID and shift to RAT. Yes of course the path labs are overloaded but there’s more to the story than that. Currently Medicare pays $110 for a PCR test, split between the path lab and whoever is collecting the sample. With tests reaching 270,000 a day that’s basically $30million per day out of fed budget.

The plan is to reduce PCR tests down to around 50,000 a day saving $24 million a day.To fill the gap the plan is to use Rapid Antigen Tests which cost around $10 in bulk. The Feds will fund 50% of whatever the states buy. In theory the states would buy enough to bridge the gap ie 220,000 per day costing them $1.1 million and the Feds the same. Meaning fed expenditure drops from $30m per day to $7million.

However that assumes the states buy enough which they haven’t. NSW has placed an order for 2 million which won’t even last 2 weeks assuming infection rates don’t increase – which of course they will.In practice what is more likely to happen is the the public will fund the majority of RATests themselves saving the Govt at least another million a day.

That million a day then becomes part of the economy which comes out as economic growth the federal government has achieved and will use to argue how good a job they’ve done.’ End Quote

This seems quite plausible to me- I will chase the source.

The other aspect is that if you do not have a PCR test and do not go to hospital, you are not recorded as a COVID case, so the statistics look better.

I personally had a contact and did a PCR at about midday on Friday 24th and got a text with a negative result at 4am on Tuesday 27th- 3 days and 16 hours later. If this blows out much more the test is virtually useless, as you would have had to isolate anyway.

It seems if we do not have a PCR test, and/or everyone does their own Rapid Antigen Test (RAT) and then monitors their own health with or without a $20 oximeter to make sure that their oxygen saturation is normal and over 95%, the whole epidemic can be ignored except for the ones so sick as to go to hospital.

This seems to be the effect of the new guidelines as in the SMH. Here is the ‘Do It Yourself’ article from the SMH:

More COVID cases told to manage themselves at home as tests hit ‘bottleneck’

By Mary WardSydney Morning Herald December 28, 2021 — 6.38pm

Private pathology companies have warned that NSW’s rising coronavirus cases are creating a “bottleneck” in the testing system as more people who catch COVID-19 are being directed to manage their infections from home.

On Tuesday, NSW Health updated its advice for people who are COVID-positive, directing that most people aged 65 and under are considered able to recover from the virus without medical involvement.

Under the new rules, people in this age group who have had two doses of COVID-19 vaccine, do not suffer from any chronic conditions and are not pregnant are considered able to safely manage an infection at home.

Previously, this was only the case for people aged under 50.Of the 42,600 COVID-19 cases reported in the state over the past seven days, fewer than 7 per cent of infections were in people aged 60 and older. About 3400 were aged in their 50s.

Those managing an infection at home should also not expect to be “cleared” from isolation by NSW Health. Instead, they may leave after day 10 of their isolation, even if they do not hear from NSW Health in a text message on this date, provided they have not experienced symptoms in the previous 72 hours.

NSW Health advice for managing common COVID-19 symptoms at home

• Cough: Breathe in steam and sip on fluids. Avoid lying on your back. If you are coughing up mucous, it is important to continue to do this as it reduces risk of a chest infection.

• Nausea, vomiting and diarrhea: Eat plain, low fibre foods. Have six smaller meals instead of three. Do not drink alcohol or caffeine. Stay hydrated.

• Fever: Take paracetemol. Put a cool, damp washcloth on your forehead. Wipe your arms and body with a cool cloth.

Source: NSW Health

“It is important that this information is provided to people who are at lower risk of severe illness to allow NSW Health to focus on those who have the greatest risk of poor outcomes, this includes people over the age of 65,” a NSW Health spokesperson said.

“Regardless of age, people are also provided clear advice about what to do if they start to feel worse or in the case of a medical emergency.

”People who have a chronic condition – such as obesity, a severe, chronic or complex medical condition, diabetes – are immunocompromised, have severe mental illness or are pregnant are urged to contact the COVID-19 Care at Home Support Line on 1800 960 933 if they return a positive PCR test to receive further medical assistance.

Last week, Australian Medical Association NSW president Danielle McMullen warned that doctors would struggle to cope with thousands of patients needing virtual care as health authorities flagged they would increasingly rely on the GP network to manage COVID-19.

Tuesday’s public holiday again meant some testing clinics were forced to shut within hours of opening, as wait times for PCR results blew out to more than four days despite the system processing fewer tests than it had previously.

There were 93,581 COVID-19 tests processed in the 24 hours to 8pm on Monday, down from the previous day’s total of 97,241 and nowhere near upwards of 150,000 tests done in September. NSW Health’s Christine Selvey said testing in the state was “under enormous pressure”, urging people to only have a PCR test if they had symptoms, were a household contact of a case or had been advised by NSW Health about attending a high transmission venue.

Premier Dominic Perrottet said he believed up to 30 per cent of tests were for interstate travel, as he and Health Minister Brad Hazzard urged the Queensland government to ease requirements for people to return a negative PCR test before crossing the border, after it scrapped a day five test for people who had already travelled to the state due to pressure on its own system.

“If we can move that PCR requirement to a rapid antigen test requirement that will significantly alleviate some of the pressure on the testing over summer,” Mr Perrottet said.Mr Hazzard said he had asked NSW Health and the federal government to reconsider whether two tests completed by returned international travellers who come through Sydney Airport needed to be PCRs, in light of the delays.

He also asked the ministry to look into recommending rapid antigen tests were used to screen pregnant women ahead of birth after the Herald revealed women had been queueing for tests every 72 hours on the advice of some hospitals.

But while private pathology labs said so-called “tourism testing” did account for some of delay, a higher volume of positive tests was also to blame. More than 6 per cent of tests reported on Tuesday were positive, up from about 2 per cent the previous week.

Greg Granger, director of strategic operations at Histopath, said the proportion of tests which were positive had created “one of the biggest bottlenecks” in the system.

Mr Granger said the method of PCR testing large volumes of samples – where samples are pooled and tested in groups – worked well when fewer than 1 per cent of tests were positive and most “pools” of tests could be cleared as negative.

“When there’s a positive in the pool every single time, you essentially have to double or triple test the samples,” he said, noting laboratories were now needing to figure out, with their available instruments, what a more efficient method would be.

“Obviously in an ideal world, you don’t pool at all. But with these sheer numbers you just can’t … it’s about finding where the balance is.

”A spokesperson for St Vincent’s Hospital, which operates the SydPath clinics, agreed positive tests took longer to confirm in its laboratory than negative ones.

They said the process of reporting a positive case to NSW Health was also “more significant” than the administration needed for a negative test.Despite the high demand, SydPath clinics will operate at reduced hours “in order to maintain the quality of [its] testing”, after more than 800 people were incorrectly sent negative test results over the weekend due to human error. The provider asked people to not attend its clinics, including the Bondi Beach drive-through, seeking a test for interstate travel.

Australian National University infectious diseases expert Associate Professor Sanjaya Senanayake said the state’s high positivity rate meant it was likely more infections were being missed by testing. However, he said, an upside of this was that the hospitalisation rate of Sydney’s Omicron wave was likely even lower than reported.

“At this stage, it does seem like the current infections are resulting in significantly fewer hospitalisations than we saw with Delta,” he said.

There were 557 COVID-19 patients in NSW hospitals on Tuesday, including 60 in intensive care, compared to 168 in hospital a fortnight ago. NSW’s COVID-19 hospitalisations reached a peak of 1266 in mid-September, including 244 in intensive care.

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Scientific Fraud

29 December 2021

I have friends who campaign for various things, sometimes quite alone for many years.

One of my friends is Polish.  He was part of the dissident movement when Solidarity was trying to end the Communist system.  While the Government was forced to negotiate with Lech Walesa, the Secret Police were busy and the second tier of activists and sympathisers simply disappeared overnight, so he spent quite a lot of time moving around.  He learned English and studied industrial hygiene, the safe use of chemicals in industry, so that he would have a qualification that was useful and recognised when he escaped to the West, which he eventually did. 

But he retained an interest in Poland and noted that some of the researchers there simply translated English papers, changed them very marginally, passed off the plagiarism as their original work, and became professors based on their great advances.  When the various academies were informed, they did not really want to know, as it disturbed their internal structures and was also something of an insult to national pride.

So he has spent years campaigning against scientific fraud, both there and here. 

There are other problems that grossly distort research.  No one really wants to publish negative findings; new discoveries are much more exciting than finding that stuff was wrong.  Also private research is much more interested in funding work that will produce a marketable product, and research that shows a drug works or is better than another.  The government has got into this mode also, wanting ‘partnerships with the private sector’ that will allow them to defray the research costs. This has arguably meant that the private sector tends to have a lot of say in what is studied, gets the government to pay for areas that it might not have bothered with, and can also grab lucrative patents early.  In this competitive environment, researchers have to find funding, and there is not much money in repeating experiments to disprove them.

Some research needs thousands of subjects to see which investigations or drugs are the most useful so that treatment protocols can be developed. Naturally these require huge coordination between many hospitals, health authorities and clinicians.  They require huge budgets. They offer big rewards if a certain investigation or treatment is shown to be beneficial and is included in the final recommendation of a huge trial.  The lead authors will travel the world for years as the definitive experts in that field with all the prestige that that entails.  Yet, as clinicians tied up with clinical work and often departments to administer, they cannot personally manage the logistics or the data and usually rely on ghost writers to put the drafts together.  Who funds that you might ask?  And what are the consequences if the funding company’s products do not work so well?  Will the professor who said it did not work get funding next time?

There is even a whole scam industry of dodgy or even non-existent  journals where you pay to be published or to be a supposed reviewer of papers.

So the pure idea that scientists are only interested in the truth and have no personal or financial interest was never true and has been under even more stress of late. 

Just as self-regulation in banking, aged care, casinos, building, advertising and many other industries has been shown to be inadequate, now scientific publishing is coming under the public spotlight.

The world of academia is more poorly set up than most industries to act as policeman. Evidence is evaluated in good faith.  Universities are expected to fund their courses from fees and donations so they are less in a position to take action that may be expensive and may damage their reputations.

Now, at last, the Australian Academy of Sciences has asked for a research integrity watchdog. This will help with deliberate individual fraud.

How much it can affect the other biasing factors in research remains to be seen.  The political and economic factors are likely to remain in the ‘too hard basket’.  It is still hard to know what the truth is.  Gut feelings about plausibility are of course ‘unscientific’ and what you ‘believe’ at a point of time is supposed to relate to what the ‘facts’ are.  And all this without social media even considered.

On the bright side, my Polish friend will see a significant step for his campaign, and if regulatory oversight replaces one lot of self-regulation there is hope that it will spread to other industries.

www.smh.com.au/national/macquarie-university-considers-investigating-suspected-research-fraud-20211214-p59hfr.html

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‘Government Responsibility’ is needed, not just ‘Personal Responsibility’.

22 December 2021

The huge, systemic and ongoing cop-out approach of the Federal and now the NSW State governments seems to be based on the hubristic belief that governments can set the agenda and influence the media to the extent of creating a perceived reality conducive to their interest. This is often successful, as the news becomes ‘What Mr Morrison did or said today.’

The narrative is changed slightly, so unless you are watching carefully, it always seems OK.

As in Animal Farm, ‘You may not sleep in a bed with sheets’. People did not remember the ‘with sheets’ bit of the slogan, but, hey, you do forget things.

But neoliberalism likes to stress individual responsibility. It allows small government, which advantages bigger players who can move into monopoly positions in an unregulated situation. It allows governments to have the perks and trappings without having to do too much as not much is expected these days.

The Federal public service is actually too small to do much except tell the States what they should do, and even this function is increasingly left to the politicians and their minders, those ambitious political science (or mainly art-law) graduates (with no scientific expertise). Hence the need for the Army when anything actually needs to be done.

But the key aspects of the current policy of getting rid of masks, social distancing restrictions, QR codes, and limits on people numbers in groups is a foolish populism and an assumption that business will do better if commerce returns to normal. This is right out of the IPA playbook.  ‘Let ‘er rip and if a few oldies and sickies die off, that is the price of society continuing’.

It also has the advantage that nothing is the government’s fault any more. If the omicron variant gets out of control, that is obviously because it is so infectious and out of the Government’s control. If the population choose not to go out to protect themselves and the businesses go broke, that is not their fault, they opened everything up (and also saved a motza by not having any more pesky jobkeeper or jobseeker payments).

To say that this non-strategy will not work is to understate the situation. We managed to control the situation when there was no vaccine. Now that there is, the governments wants to throw away all public health norms for infectious disease and rely on vaccination alone. This has conspicuously not worked in Europe.  Look at the Daily Case histograms (see link below) for Denmark, the UK, France, Spain and Italy. It seems that Germany, Belgium and the Netherlands have managed to begin to turn around the latest spike, but I have not researched their latest policy changes. Israel, largely triple-vaxxed is doing better. The US has a rising spike- it will be interesting what happens with their poorly vaccinated population.

But there is no need to look overseas.  The Australian graph is already rocketing up with new highs reached every weekday.  We are not triple-vaxxed and now there is another vaccine shortage.  NSW yesterday was responsible for 3763 of the national total of 5724 (66%) and the percentage is rising.  So Perrottet is as bad as Morrison.  (Figures from covid19data.com.au).

Individuals cannot protect themselves when the virus is everywhere unless they become hermits, and even then they will have trouble getting fed.  It needs mass action. It is a public health problem that needs government action. This is so obvious that it is extraordinary that it should even need to be stated.  But our governments have reached such a low level of effectiveness that we are in grave danger.  The Lucky Country is about to squander its advantages yet again.  We can only hope that the National Cabinet meeting is the platform for a national about face. 

Please protect yourselves and try to get the governments to see reason.

May be a cartoon of ‎one or more people, people standing, suit and ‎text that says "‎We're هll about taking personal responsibility And if this approach turns out to be disaster? Then you'll have only yourselves to blame. wikak‎"‎‎
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Mental Health and Physical Health

11 November 2021

The Health system has a major divide that is not often spoken about- the divide between mental health and physical health. 

Physical health tries to be a science and likes to think that its diagnoses and treatments are based on sound experimental evidence. If someone is sick and there are not enough facilities there is a fair effort from the medical profession and relatives to get more resources and they are mostly successful.  There is a highly respected system and career structure.

Mental health has similar endeavours, but has less of a scientific base for its diagnoses and treatments.  There has been a lot of work on neurotransmitters associated with depression and drugs that supposedly increase the good ones, but no single test is associated with a diagnosis, and diseases are defined.  It gives it a lingering stigma of imprecision.

The workforces in mental and physical health have relatively little crossover, even isolated within the same hospital. When I last worked in the health system 9 years ago in a hospital that had both an active ED and a mental health facility, patients were triaged as physical or mental, different teams saw them, and neither team wanted much to do with the other stream’s patients.  There was a shared waiting room, but different personnel, assessment areas, practices and wards.  Getting one of the other team to assess someone was an afterthought, or only when the pathology was fairly gross.

When I was in tobacco control, there was a lot of reluctance to try to get mental health patients to stop smoking as ‘they needed it’, which was another way of saying that to add the nicotine withdrawal to their generally stressed situation was merely making trouble.  But the public health statisticians said that people with mental health problems had a lot of physical problems and died about 14 years earlier (AIHW).  So glossing over the physical health of mental health patients is not without consequence.

It was interesting to note recently that a COVID-19 infection in a mental health inpatient went undiagnosed for 4 days, and drew attention to the fact that mental health patients had a poor vaccination rate also.

www.smh.com.au/national/nsw/hospital-patient-s-covid-19-infection-undetected-for-four-days-20211105-p596aw.html

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iCare will repay 53,000 underpaid injured workers

11 November 2021

iCare, the State workers’ compensation insurer has admitted that it has underpaid thousands of workers and will now repay them, according to an article in today’s SMH.

This story has been leaking out in the media for ages.  At a day to day level, my patients have always complained that they get a lot less in compo than they got before their injury. This has been even for workers on regular salaries. Those on casual work were in a worse situation as there was some argument about what their PIAWE (Pre-Injury Average Weekly Earnings) were, especially if they got variable hours from a labour-hire company.

When this scandal first broke, I tried to tell my patients to ask iCare if they had been underpaid and some did.  It seemed that iCare could not work out what their PIAWEs were. It did not have the data. In that employers’ future premiums related to how much was paid out in claims, it suited both the employers and the insurers to minimise their PIAWE, so if a low amount was put in, there was little incentive to check it up.  Now, a few years later, iCare would need a forensic accountant going through the employer’s books to get to the correct amount. This is unlikely to happen.

So while this promise is a start, it is hard to believe that it will be enough to see justice done.

Workers’ Compensation has always been seen as a cost for business rather than a moral obligation to pay for people injured at work. Generally it is about minimising the cost of the payout, rather than having an energetic injury prevention programme.

The Minister in charge is the Treasurer, so all of this happened on Dominic Perrottet’s watch. Matt Kean, the new Treasurer may be more sympathetic, and this will help, but we still need a lot better enforcement of safety to prevent accidents, and much more power to injured people to ensure that they are correctly paid.

It illustrates that active Unions are necessary to redress the power imbalances in the the system. Legislation without enforcement is just words on a page, just as apologies from banks and insurance companies for rip-offs are just sound vibrations in the air.

Here is the article:

‘My sincere apology’: iCare will pay back $38 million to 53,000 injured workers

Lucy Cormack          SMH   November 11, 2021

State insurer iCare will pay $38 million to 53,000 largely underpaid injured workers affected by historic miscalculation errors between 2012 and 2019.

An iCare review of 16,000 injured worker case files has revealed an average error rate of 3.5 per cent or an underpayment of $26 a week due to miscalculated pre-injury average weekly earnings.

“I would like to offer my sincere apology to any injured worker who has been affected by this calculation error,” said ICare chief executive Richard Harding.

Among the most seriously injured and affected are 523 workers underpaid a total of more than $3.9 million, or around $7500 each.

The mass pay-out follows a joint investigation by The Sydney Morning Herald, The Age and ABC’s Four Corners which last year revealed iCare had underpaid as many as 52,000 injured workers by up to $80 million in compensation.

ICare then disputed the underpayment figures, saying it believed only 5000 to 10,000 workers had been underpaid up to $10 million in total.

Chief executive officer Richard Harding on Thursday said affected employers and employees had been unable to provide the data to accurately assess underpayments. As a result, iCare conducted a “file by file review” of 16,000 cases as a sample to assess the scale of the errors.

“We’ve been advised there is a risk of overcompensation in this approach, but the desire is to get money back as quickly as possible,” Mr Harding said.

“I would like to offer my sincere apology to any injured worker who has been affected by this calculation error.”

The underpayments were caused by errors in the calculation of pre-injury average weekly earnings for injured workers dating back to 2012, when the insurance scheme was run by WorkCover.

Mr Harding said the average lump sum to be paid to the 53,000 workers will be around $700. However, some will receive thousands.

Affected workers will receive any money owed through an adjustment of their weekly benefits for the weeks already paid. Any historical overpayments caused by the same miscalculation error will not be recouped by iCare.

Revelations of financial mismanagement and widespread underpayment across the iCare stable first emerged last year, before a subsequent review into its culture and governance revealed systemic weaknesses and a failure to hold management to account.

Labor treasury spokesman Daniel Mooched said the announcement repudiated earlier claims that only a small number of people were affected.

“As always with iCare, the devil is in the detail. But today’s announcement is meaningful for the tens of thousands of people iCare underpaid”.

Mr Mookhey said the insurer must guarantee that it will not seek to recover the money from sick and injured workers through benefit cuts or employers through higher premiums.

Upper house Greens MP David Shoebridge said the pay-out to workers followed years of chasing by unions, injured workers and non-government MPs.

While he welcomed the payments, he said there was “no evidence from iCare that this payment goes anywhere near meeting their full obligation to injured workers”.

“We will continue to press iCare for a full accounting so that no injured worker is left short-changed,” he said.

Unions have described the decision to reimburse workers as a significant step but called for greater transparency about the process.

“This is hardly an organisation that can be taken at its word. iCare executives, who are better known for receiving fat bonuses, must detail their methodology,” said Mark Morey, Secretary of Unions NSW.

Last week, a budget estimates hearing heard iCare had reported a $1.4 billion underwriting loss in the past year, with the total accumulated loss of the past three years now exceeding $6 billion.

Treasurer Matt Kean, who is responsible for iCare, told the hearing new legislation following recommendations from another review prompted by the scandal would not be introduced until 2022.

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